# LEBANON FAMILY DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295593457
- **Authorized official:** ROBIN RICARDO DANIEL MD, DDS (OWNER)
- **Authorized official phone:** (615) 830-2176

## Contact information

- **Practice address:** 1430 W BADDOUR PKWY STE B, LEBANON, TN 37087-2656
- **Practice address phone:** (931) 704-0834
- **Mailing address:** 1430 W BADDOUR PKWY STE B, LEBANON, TN 37087-2656
- **Mailing address phone:** (931) 704-0834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |

## Other

- **Enumeration date:** 03/11/2024
- **Last updated:** 04/16/2024